Purpose: Unresectable hepatocellular carcinoma (HCC) is often treated with sorafenib or transarterial chemoembolization (TACE) for palliation. Cancer patients on aspirin or clopidogrel see improved survival. Addition of antiplatelet therapy can improve outcomes as seen in this case series of patients with liver cancer.
HCC develops from platelet mediated cytotoxic T lymphocyte liver damage. Sorafenib, aspirin and clopidogrel act via depletion of platelets and also reduce carcinogenic intrahepatic cytotoxic T lymphocytes. Mean progression free survival on treatment is dismal; sorafenib (5.5 mo), TACE (3.9 mo). and TACE plus sorafenib (6.3 mo.). Median overall survival on sorafenib, TACE, and TACE + sorafenib are 10.7, 19-20 mo, and 12 mo, respectively.
Background: 5 male HCC patients were treated with sorafenib and/or TACE and aspirin, clopidogrel, or both. They all underwent triphasic CT scans. Case 1: Age 55 years, male, 2x2 cm lesion; received sorafenib 200 mg twice daily, 81 mg aspirin, and 75 mg clopidogrel. The patient achieved complete remission twice and was alive at 7 years 2 mo. Case 2: Age 69 years, male, 5x5 cm HCC; received TACE once and took 81 mg aspirin daily. He achieved radiographic complete remission and was alive at 43 mo 9 days. Case 3: Age 67 years, male, 6 x 6 cm HCC; had TACE once and 81 mg aspirin daily. Patient had complete remission at 32 mo and 16 days. Case 4: Age 72, male, 2 x 2 cm HCC; had TACE and 81 mg aspirin. He achieved complete remission at 14 months. Case 5: Age 68 years, male, 8 x 5 cm HCC; previously failed TACE and sorafenib. The patient presented with weight loss, class Child C cirrhosis, large volume ascites; alpha-fetoprotein (AFP) 208,960 ng/mL. He started on baby aspirin, diuretics and hospice care. A month later, his ascites decreased and he began sorafenib 200 mg twice daily. 3 months later the AFP dropped to 83,000 ng/mL. 5 months later, AFP 5950 ng/mL, tumor 3x2 cm; no ascites. 13 mo later: AFP 34,620 ng/mL, alive, asymptomatic.
Conclusion: These cases achieved progression free survival and overall survival significantly better (3-4x) than historical controls. Childs C cases might also benefit from adding aspirin or clopidogrel to sorafenib. Antiplatelet medication merits further study in hepatocellular cancer treated with sorafenib or TACE.
